Is my current diabetes regimen of insulin, metformin, and Empagliflozin appropriate with fasting blood sugars of 100-160 mg/dL and postprandial sugars of 200-260 mg/dL?

Your Current Diabetes Regimen Requires Immediate Intensification

Your blood sugar levels are not adequately controlled and your insulin doses need to be increased significantly, with your fasting sugars of 100-160 mg/dL being borderline but your postprandial (after-meal) sugars of 200-260 mg/dL being dangerously elevated. This indicates both insufficient basal insulin coverage and inadequate mealtime insulin dosing 1.

Immediate Adjustments Required

Basal Insulin (Morning Dose) Titration

• Increase your morning insulin (currently 28 units) by 4 units every 3 days until your fasting blood sugar consistently reaches 80-130 mg/dL 1
• Since your fasting sugars are 100-160 mg/dL, you need aggressive titration with 4-unit increments rather than 2-unit increments 1
• Continue this escalation until fasting targets are met, monitoring daily 1

Prandial Insulin (Evening Dose) Intensification

• Your evening dose of 18 units is clearly insufficient given postprandial sugars of 200-260 mg/dL 1
• Increase your evening insulin by 2-4 units every 3 days based on your 2-hour post-dinner blood sugar readings 1
• Target postprandial glucose should be less than 180 mg/dL 1

Critical Threshold Monitoring

• Watch for signs of "overbasalization" when your total basal insulin exceeds 0.5 units/kg/day 1
• If you continue having high postprandial sugars despite increasing basal insulin to this threshold, you may need to add additional mealtime insulin coverage before lunch and breakfast rather than continuing to escalate basal insulin alone 1

Your Oral Medications

Metformin (Reclimet)

• Your current dose of 30 mg twice daily appears to be a non-standard formulation - standard metformin dosing is typically 500-1000 mg twice daily, up to a maximum of 2000-2550 mg daily 1
• Verify with your physician that you're on the correct dose and formulation 1
• Metformin should be continued at maximum tolerated dose when intensifying insulin therapy, as this combination provides superior glycemic control with reduced insulin requirements 1

Empagliflozin (Istavel Empa)

• Continue this medication once daily - it provides complementary glucose-lowering through a different mechanism and offers cardiovascular benefits 2, 3
• The combination of empagliflozin with metformin and insulin is safe and effective, reducing HbA1c by an additional 0.7-0.8% 3, 4
• This medication also helps with weight management and blood pressure control 5, 6

Daily Monitoring Requirements

• Check fasting blood sugar every morning to guide your basal insulin adjustments 1
• Check blood sugar 2 hours after your largest meal (likely dinner) to guide your prandial insulin adjustments 1
• Keep a log of all readings to identify patterns every 3 days 1

When to Add More Mealtime Insulin

• If your basal insulin dose exceeds 0.5 units/kg of your body weight (calculate: your weight in kg × 0.5) and your postprandial sugars remain elevated, you need to add rapid-acting insulin before lunch and breakfast 1
• Start with 4 units before the meal causing the greatest glucose spike, or use 10% of your current basal dose 1
• This prevents "overbasalization" - a dangerous pattern where excessive basal insulin causes hypoglycemia between meals while postprandial sugars remain high 1

Hypoglycemia Prevention

• If you experience blood sugar below 70 mg/dL, immediately consume 15 grams of fast-acting carbohydrate, recheck in 15 minutes, and reduce your insulin dose by 10-20% 1
• Always carry glucose tablets or a fast-acting carbohydrate source 1
• If hypoglycemia occurs without clear cause, reduce the corresponding insulin dose immediately 1

Critical Pitfalls to Avoid

• Do not continue your current regimen unchanged - postprandial sugars of 200-260 mg/dL significantly increase your risk of long-term complications 1
• Do not stop metformin when intensifying insulin unless contraindicated - the combination is superior to insulin alone 1
• Do not wait longer than 3 days between insulin adjustments in stable conditions - this unnecessarily prolongs time to achieve glycemic targets 1
• Do not rely solely on fasting sugars - your postprandial control is equally important and currently inadequate 1

Expected Outcomes

• With proper insulin titration, you should achieve fasting glucose of 80-130 mg/dL and postprandial glucose below 180 mg/dL within 2-4 weeks 1
• Your HbA1c should improve significantly with these adjustments 1
• The combination of empagliflozin with optimized insulin therapy provides superior outcomes compared to insulin intensification alone 2, 3

When to Contact Your Healthcare Provider

• If fasting glucose remains above 160 mg/dL after 2-3 weeks of titration 1
• If you experience recurrent hypoglycemia (blood sugar below 70 mg/dL) 1
• If your total basal insulin dose exceeds 0.5 units/kg/day without achieving fasting glucose targets 1
• Before making any changes to your metformin dose or formulation 1